Facility Evaluation Report

Licensing Program Analyst (LPA) Galarza conducted an unannounced Case Management- Incident visit in response to Client (C1’s) Death Report that was submitted on 9/5/2022. LPA explained the purpose of today's visit to staff Alongia Jenkins and conducted a health & safety check of clients in care. Administrator was explained the purpose of the visit telephonically.

During today's visit LPA toured the facility and reviewed client (C1's) file. No signs of neglect, abuse or other immediate health and safety threats were observed. LPA obtained copies of the following documents:

· Medication Administration Records (August 2022 & September 2022)

LPA requested the facility obtain a copy of the death certificate from LA County Registrar's office, and the LA County Coroner's autopsy report. A copy of the death certificate and autopsy report shall be provided to Community Care Licensing upon receipt.

An exit interview was conducted and a copy of the report was provided to staff Alongia Jenkins.